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ACUTE EXPOSURE INFORMATION

USES: One of the toxic alcohols that is found in windshield wiper fluid, gas line antifreeze, fuels, photocopy fluid, solvents, carburetor cleaner, and as an adulterant in homemade ethanol distillates.

TOXICOLOGY: An alcohol that causes intoxication similar to ethanol and is metabolized to formaldehyde and formic acid via alcohol dehydrogenase and aldehyde dehydrogenase, respectively. Formic acid causes a metabolic acidosis and causes blindness through direct retinal toxicity. Toxicity is most common after ingestion but has been reported with inhalation and dermal exposures.

EPIDEMIOLOGY: Uncommon exposure that can result in significant morbidity and mortality.

WITH POISONING/EXPOSURE

MILD TO MODERATE TOXICITY: Patients will initially have signs of acute intoxication, such as ataxia, sedation, and disinhibition. Patients may also complain of abdominal pain, nausea, vomiting, and headache. Acidosis or signs of visual impairment suggest a more severe poisoning.

SEVERE TOXICITY: Severe metabolic acidosis develops hours after exposure (if ethanol is not coingested) and may lead to multiorgan dysfunction including hypotension, tachycardia, dysrhythmias, seizures, coma, and pancreatitis. In addition, ocular toxicity may develop; manifestations include mydriasis, hyperemic optic discs, and papilledema. Visual impairment may develop, which may range from blurry/hazy vision to color vision defects to "snowfield" vision to total blindness. Permanent sequelae after severe intoxication may include basal ganglia necrosis with parkinsonian features (ie, tremor, rigidity, bradykinesia) and blindness.